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MIDW2001 Complexities In Childbearing > Multiple pregnancy > Flashcards

Flashcards in Multiple pregnancy Deck (14):
1

define multiple pregnancy

when 2 or more eggs are released and fertilised (dizygotic twins)

or when a single fertilised egg divides early to form identical embryos (monozygotic twins)

2

what is the incidence of twins

twins- 1 in 90 pregnancies
triplets- 1 in 8100 pregnancies

3

when is having twins more common

african origin
recent OCP discontinuation
assisted conception

DZ twins more common in:
older mothers
increasing parity
maternal family history

4

what are dizygotic twins?

each twin is separate individuals with its own planet, amnion and chorion

from 2 separate fertilised eggs

essentially just siblings

fraternal twins

5

what are monozygotic twins?

identical

roughly 1/3 of twin pregnancies
about 1% are conjoined
connection between fetal circulations via the placenta
same genes, blood group, physical features,
may be separated by chorion

3 kinds of MZ twins dependant on when divide occurs

6

what are the 3 types of MZ twins?

DCDA
DCMA
MCMA

7

what are the risks with MCMA?

conjoined twins

cardiac twin/twin reversal arterial perfusion syndrome

TTTS- renal?

IUGR - usually one twin

cord entanglement

8

what are the maternal problems?

exacerbation of minor disorders

anaemia

PIH

APH

9

what are the fetal problems?

fetal malpresentation

locked twins can occur with a breech and vertex presentation

cord problems - prolapse, velametous insertion, entanglement

preterm labour

mode of delivery

10

what is the management for birth?

likely to labour early - 60% spontaneous before 37/40, the more foetuses the earlier labour will start

obstetric advice - IOL 38/40 DC, 36-37 MC

if 1st twin cephalic - vaginal birth encouraged

if the presentation for triplets - ELCS

duration of labour should be same as singleton, increased risk due to distended uterus

11

what is the management for labour?

CTG or 2 topples or poniards

mobilisation encourager

extra comfort support

may require epidural in case of manipulation of 2nd twin

if fetal distress EMCS

poor uterine action - oxytocics

babies may be preterm

12

outline the birth of twin 1

normal birth, note time, label, tag baby and cord

reassurance for patrons and good communication

baby to mum/dad in good condition

13

outline the birth of twin 2

ascertain lie of 2nd twin by USS
confirm by VE
ARM after PP engaged, obstetrician may stabilise 2nd twin
Increased risk of fetal compromise due to position or placental separation
wait up to 45 mins for 2nd twin so long as all is well
uterotonic after after 2nd twin
CCT to both cords simultaneously
examination of placenta and histology

14

what complications can occur?

common:
polyhydramnios
malpresentation
PROM
cord prolapse
delay in 2nd twin
PPH

rare:
conjoined twin
locked twins
TRAP
TTTS
vanishing twin